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IEGA LOT N0. � <br />DE50. � <br />OW ER <br />0 V <br />TENANTNAME <br />CONTRACTOR <br />PHONE <br />PROPOSED USE OF BUILDING <br />� F �2 <br />�cRMIT APPLICAT�JN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />BLOCK <br />CONTRACT PRICE OF WORK � j� <br />WORK OESCRIPTION <br />, <br />�� �•! ru ✓1� <br />NO. I TYPE OF FIXTURE OR REM <br />WATER CLOSEI' �"� <br />� BATHTUB �� <br />S_ LAVATORY (WASH BASIN) +�r- <br />I SHOWER � <br />�KITCHEN SINK & DISPOSAL i <br />DISHWASHER <br />� LAUNGRYTRAY <br />I CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />� FLOOR DRAIN <br />BACKFLOW PREVENT�R <br />SINK (SERVICE/8AR/MOP/ETC.) <br />OTHER <br />PARCEL TAX I.D. N <br />_ ��s�� _nn��_,�i�_ <br />CONTACTNAME <br />ADDRESS <br />Building Mechanical <br />PeaMIT gCombinetion Plumhing <br />7vPE B Demolition Sign <br />Sprinkler <br />� F� <br />PERMIT N <br />coa <br />PHONE <br />�, <br />ZIP CONTR. LICENSE N <br />Addition HEAT SOURCE <br />WORK Alteralion Electric <br />TYPE New �Gas <br />Repair/Meint Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />3 �/.L �<«�c� <br />71 `J <br />-r � � �'�� :o <br />- �, _�, �; . � <br />N0. I TYPE OF FI%TURE OR ITEM <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLC ES DRYER <br />RANGtH00D <br />WATER HEATER <br />MF fAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />�XHAUSTFAN <br />OTHER <br />I HERE9Y CERITIF'r'HAT I HAVE READ AND EXAMINE� THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PPOVISIONS OF UWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PFESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL L1W REGULITING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED B`' THE <br />OWNEWOF THIS PFiOPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />rntirdACTORS LFIWA827 RC'N AMO 2@6.200 WAC. <br />1/ <br />�� J� y/ ✓ <br />